Chow James C, Sensinger Jon, McNeal David, Chow Bettina, Amirouche Farid, Gonzalez Mark
Department of Orthopaedic Surgery, M/C 844, University of Illinois at Chicago, 835 S. Wolcott Avenue, Chicago, IL 60612-3748 USA.
Department of Mechanical Engineering, University of Illinois at Chicago, 2027 Engineering Research Facility, 842 W. Taylor Street, Chicago, IL 60607 USA ; Department of Bioengineering, University of Illinois at Chicago, 2027 Engineering Research Facility, 842 W. Taylor Street, Chicago, IL 60607 USA.
Hand (N Y). 2014 Mar;9(1):105-11. doi: 10.1007/s11552-013-9547-0.
The A2 and A4 pulleys have been shown to be important in finger flexor tendon function. Other authors have suggested either reconstruction or venting of portions of these pulleys in an attempt to preserve finger function in certain clinical situations. This study examines the effects of partial incision of these pulleys on finger flexion kinematics and biomechanics.
The index and ring fingers of 16 cadaveric hands were studied. The flexor digitorum profundus tendon was isolated and attached to a computer driven servo-motor. Micro-potentiometers measured flexion angles of the metacarpophalangeal, proximal inter-phalangeal and distal inter-phalangeal joints. Joint inertial torques were calculated making use of this experimental kinematic data.
Proximal 50 % incisions of either the A2 or the A4 pulleys resulted in a statistically significant decrease in overall finger motion. This effect was greatest in the proximal inter-phalangeal joint, with a decrease in joint motion, as well as an earlier time to initiation of motion. These changes in finger motion were more pronounced with A2 pulley incision than they were with A4 pulley incision, but the changes were statistically significant in either case. No significant changes in joint inertial torques were shown.
Our data provides evidence to the importance of the proximal portions of the A2 and A4 pulleys, and may support partial distal incision of these pulleys in certain clinical situations.
已证明A2和A4滑车在手指屈肌腱功能中起重要作用。其他作者建议对这些滑车的部分进行重建或开窗，以试图在某些临床情况下保留手指功能。本研究探讨这些滑车部分切开对手指屈曲运动学和生物力学的影响。
对16具尸体手的示指和环指进行研究。分离指深屈肌腱并将其连接到计算机驱动的伺服电机上。微型电位计测量掌指关节、近端指间关节和远端指间关节的屈曲角度。利用该实验运动学数据计算关节惯性扭矩。
A2或A4滑车近端50%切开导致手指整体运动在统计学上显著减少。这种影响在近端指间关节最为明显，关节运动减少，且运动起始时间提前。与A4滑车切开相比，A2滑车切开时手指运动的这些变化更明显，但两种情况下变化均具有统计学意义。关节惯性扭矩未见显著变化。
我们的数据证明了A2和A4滑车近端部分的重要性，并可能支持在某些临床情况下对这些滑车进行部分远端切开。
